| The Health Insurance Portability and Accountability
Act of 1996 (HIPAA) imposes numerous requirements on employer
health plans concerning the use and disclosure of individual
health information. This information, known as protected
health information, includes virtually all individually
identifiable health information held by the Plan — whether
received in writing, in an electronic medium, or as an
oral communication. This notice describes the privacy practices
of the Health Care Spending Accounts. The plan(s) covered
by this notice may share health information with each other
to carry out Treatment, Payment, or Health Care Operations.
These plans are collectively referred to as the Plan in
this notice, unless specified otherwise.
The Plan’s duties with
respect to health information about you.
The Plan is required by law to maintain the privacy of your health information
and to provide you with this notice of the Plan’s legal duties and privacy
practices with respect to your health information. If you participate in an insured
plan option, you will receive a notice directly from the Insurer. It’s
important to note that these rules apply to the Plan, not Waco Independent School
District (“WISD”) as an employer — that’s the way the
HIPAA rules work. Different policies may apply to other WISD programs or to data
unrelated to the health plan.
The privacy rules generally allow the use and disclosure of your health information
without your permission (known as an authorization) for purposes of health care
Treatment, Payment activities, and Health Care Operations. Here are some examples
of what that might entail:
- Treatment includes providing, coordinating,
or managing health care by one (1) or more health care
providers or doctors. Treatment can also include coordination
or management of care between a provider and a third
party, and consultation and referrals between providers.
- Payment includes
activities by this Plan, other plans, or providers
to obtain premiums, make coverage determinations and
provide reimbursement for health care expenses. This
can include eligibility determinations, reviewing services
for medical necessity or appropriateness, utilization
management activities, claims management, and billing;
as well as “behind the scenes” plan
functions such as risk adjustment, collection, or reinsurance.
- Health Care Operations include activities by this Plan
(and in limited circumstances other plans or providers)
such as quality assessment and improvement activities,
customer service, and internal grievance resolution. Health
care operations also include vendor evaluations, credentialing,
training, accreditation activities, underwriting, premium
rating, arranging for medical review and audit activities,
and business planning and development.
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